Madison Medical Center

All Charges

Charge

Type

Setting

Price

ACETYLCYS (10% 10ML) 100MG/1000ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697739
Hospital Revenue Code	250
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$139.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

ACETYLCYS (10% 10ML) 150MG/200ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697737
Hospital Revenue Code	250
Rate for Payer: Cash Price	$175.50

ACETYLCYS (10% 10ML) 150MG/200ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697737
Hospital Revenue Code	250
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$139.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

ACETYLCYS (10% 10ML) 50MG/500ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697738
Hospital Revenue Code	250
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$139.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

ACETYLCYS (10% 10ML) 50MG/500ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697738
Hospital Revenue Code	250
Rate for Payer: Cash Price	$175.50

ACETYLCYS (10% 30ML) 1000MG/1000ML IVPB

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697742
Hospital Revenue Code	250
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$212.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$175.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$212.06
Rate for Payer: Cash Price	$267.30
Rate for Payer: UnitedHealthcare Commercial	$198.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$106.92

ACETYLCYS (10% 30ML) 1000MG/1000ML IVPB

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697742
Hospital Revenue Code	250
Rate for Payer: Cash Price	$267.30

ACETYLCYS (10% 30ML) 50MG/500ML IVPB

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697741
Hospital Revenue Code	250
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$212.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$175.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$212.06
Rate for Payer: Cash Price	$267.30
Rate for Payer: UnitedHealthcare Commercial	$198.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$106.92

ACETYLCYS (10% 30ML) 50MG/500ML IVPB

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697741
Hospital Revenue Code	250
Rate for Payer: Cash Price	$267.30

ACETYLCYSTINE 20% 10ML SOL ORAL/INH

Facility

$40.00

Service Code	HCPCS J7608
Hospital Charge Code	2624669
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

ACETYLCYSTINE 20% 10ML SOL ORAL/INH

Facility

$40.00

Service Code	HCPCS J7608
Hospital Charge Code	2624669
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

ACETYLCYSTINE 20% 30ML INJ IV ONLY

Facility

$992.00

Service Code	HCPCS J7608
Hospital Charge Code	2623575
Hospital Revenue Code	250
Rate for Payer: Cash Price	$892.80

ACETYLCYSTINE 20% 30ML INJ IV ONLY

Facility

$992.00

Service Code	HCPCS J7608
Hospital Charge Code	2623575
Hospital Revenue Code	250
Min. Negotiated Rate	$357.12
Max. Negotiated Rate	$708.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$587.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$708.29
Rate for Payer: Cash Price	$892.80
Rate for Payer: UnitedHealthcare Commercial	$661.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$357.12

ACETYLCYSTINE 20% 30ML SOL ORAL/INH

Facility

$992.00

Service Code	HCPCS J7608
Hospital Charge Code	2654038
Hospital Revenue Code	250
Rate for Payer: Cash Price	$892.80

ACETYLCYSTINE 20% 30ML SOL ORAL/INH

Facility

$992.00

Service Code	HCPCS J7608
Hospital Charge Code	2654038
Hospital Revenue Code	250
Min. Negotiated Rate	$357.12
Max. Negotiated Rate	$708.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$587.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$708.29
Rate for Payer: Cash Price	$892.80
Rate for Payer: UnitedHealthcare Commercial	$661.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$357.12

ACETYLCYSTINE(MUCOMYST)10% 10ML SOL

Facility

$75.00

Service Code	HCPCS J7608
Hospital Charge Code	2654036
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

ACETYLCYSTINE(MUCOMYST)10% 10ML SOL

Facility

$75.00

Service Code	HCPCS J7608
Hospital Charge Code	2654036
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

ACETYLCYSTINE(MUCOMYST)10% 30ML SOL

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697740
Hospital Revenue Code	250
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$212.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$175.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$212.06
Rate for Payer: Cash Price	$267.30
Rate for Payer: UnitedHealthcare Commercial	$198.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$106.92

ACETYLCYSTINE(MUCOMYST)10% 30ML SOL

Facility

$297.00

Service Code	HCPCS J7608
Hospital Charge Code	2697740
Hospital Revenue Code	250
Rate for Payer: Cash Price	$267.30

ACETYLCYSTINE(MUCOMYST)10% SOL 30ML

Facility

$178.00

Service Code	HCPCS J7608
Hospital Charge Code	2697260
Hospital Revenue Code	250
Rate for Payer: Cash Price	$160.20

ACETYLCYSTINE(MUCOMYST)10% SOL 30ML

Facility

$178.00

Service Code	HCPCS J7608
Hospital Charge Code	2697260
Hospital Revenue Code	250
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

ACETYLMORPHINE CONFIRMATION

Facility

$142.00

Service Code	CPT 80356
Hospital Charge Code	2280400
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

ACETYLMORPHINE CONFIRMATION

Facility

$142.00

Service Code	CPT 80356
Hospital Charge Code	2280400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$127.80

ACHR ANTIBODIES COMP PROF

Facility

$425.00

Hospital Charge Code	2286367
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$303.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$251.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$303.45
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$153.00

ACHR ANTIBODIES COMP PROF

Facility

$425.00

Hospital Charge Code	2286367
Hospital Revenue Code	301
Rate for Payer: Cash Price	$382.50

Know your out-of-pocket cost for care.

All Charges